Active NPI
Traci Shahan, WHNP-BC
- Obstetrics & Gynecology Nurse Practitioner
- Longmont, CO
National Provider Identifier
1871777193
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Nurse Practitioner
- License
- 3082
- Practice address
- 600 S Airport Rd BLDG a
Longmont, CO 80503-6424 - Phone
- (720) 378-6900
- Fax
- (877) 241-8199
- NPI assigned
- Dec 21, 2007
- Last updated
- Oct 25, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Nurse Practitioner | 363LX0001X | 3082 | CO | Primary |
Addresses
Primary practice location
600 S Airport Rd BLDG a
Longmont, CO 80503-6424
Mailing address
600 S Airport Rd BLDG a
Longmont, CO 80503-6424
Phone (720) 378-6900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 112531 | Other | CO | NURSING LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 30, 2017 through Jan 30, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3082 | CO | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1508889600000",
"number": "1871777193",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 S AIRPORT RD BLDG A",
"city": "LONGMONT",
"state": "CO",
"postal_code": "805036424",
"telephone_number": "720-378-6900",
"fax_number": "877-241-8199"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 S AIRPORT RD BLDG A",
"city": "LONGMONT",
"state": "CO",
"postal_code": "805036424",
"telephone_number": "720-378-6900",
"fax_number": "877-241-8199"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAHAN",
"first_name": "TRACI",
"name_prefix": "Dr.",
"credential": "WHNP-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-12-21",
"last_updated": "2017-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "363LX0001X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Obstetrics & Gynecology",
"state": "CO",
"license": "3082",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NURSING LICENSE",
"identifier": "112531",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Longmont, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.